by brant bullard | Feb 29, 2016 | News
The Right Dose For Your Genes – A Test of a Lifetime
By Sheila Robinson, Staff Writer
The Lawton Constitution
Jennifer Flowers, a medication aide at McMahon Tomlinson Nursing & Rehabilitation Center, carefully sorts medications for patients.
One pill doesn’t work the same for everybody. If researchers tried to come up with one perfect pill, it just wouldn’t work the same for every person.
Pharmacogenetics is the study of variations of DNA and RNA characteristics as related to drug response. It can be difficult to predict who will benefit from a medication, who will not respond at all, and who will experience adverse effects.
Pharmacogenetics seeks to understand how differences in genes and their expression affect the body’s response to medications.
At McMahon Tomlinson Nursing & Rehabilitation Center, some 70 to 75 patients have undergone DNA testing with the assistance of their physician, the center and PGx Medical, according to J.R. Gutierrez, administrator of the center.
“We started, I think, in the summer of 2015,” Gutierrez said. “I had previous experience with it in the past at another facility. For example just in psychotropic medications, these are antidepressants or medicines for any residents that have depression or any kind of psychotropic conditions. Its great to be able to test them against 32 different medicines without giving them the medicine.”
Gutierrez said now they can also test for cardiac and pain medications.
“When we can take a resident, ultimately what we do is swab the inside of their mouth,” he said. “We just swab saliva from the inside of their mouth and that is what we send off to test. They test this against a battery of different medications. Then the results they give us tell us if there are any contraindications of medications patients are currently on for possible reactions. There are some medications that they don’t metabolize well.”
In other words, patients may not be getting the desired effect from medications they are taking. Although medical professionals in Lawton work with the PGx Medical office in Edmond, swabs are sent to PGx Medical’s processing laboratory in San Diego via Secure FedEx. Results are returned to the Lawton nursing center in about a week.
“We have been alerted to some drug interactions,” Gutierrez said. “Physicians have changed the medication that residents are getting. I think we have also seen, based on the results, that there’s other medications that would work better. The results will be flagged like a red, yellow, green. The red flag is there’s a potential drug interaction or they are not metabolizing it well. The yellow ones, they do OK on it; and the green one is they do well on it.”
Clay Bullard, president of PGx Medical, said their team works with physicians and care providers who are desiring to in- crease medical efficiencies, re- duce cost, increase better outcomes and ultimately do the best they can for each individual patient.
“PGx is very excited that several of the physicians within the Lawton area have embraced this definitive scientific tool to help guide them in the best and most appropriate medications to prescribe, based upon that patient’s unique metabolization profile,” Bullard said.
Gutierrez gave an analogy to help explain why the process has been used and how it created positive results.
“If you picture going to the doctor’s office for any condition, and the doctor says ‘Here, this normally works for this condition,” he said. “You take it and the doctor says we won’t know if it’s going to work for two or three weeks. Can you imagine doing that 32 times? As opposed to just swabbing right now and I’m testing it against 32 medications and within a week, I have the results.”
In Oklahoma, Medicare B, Medicaid and most health insurance companies cover the cost of the test, according to Kelly Burleson, director of marketing at PGx.
Residents at Tomlinson Nursing & Rehabilitation Center have had no out-of-pockets costs, Gutierrez said. The testing company has accepted what Medicare or insurance has paid them.
“I think the most important thing is with this metabolic testing, people don’t have to be guinea pigs at this point for probably 60 or 70 different medications,” Gutierrez said. “The doctors don’t have to be guessing as to which medication will work on people if they had this done already and had the test.”
Additional information about pharmacogenomics can be found online at www.pgxmed.com,
or contact PGx Medical at 405-509-5112 or info@pgxmed.com
Benefits of pharmacogenomics
Pharmacogenomics offers important benefits:
■ Improves patient safety. It is estimated that severe drug reactions cause more than 120,000 hospitalizations each year. Pharmacogenetic testing may help identify patients who are likely to experience dangerous reactions to drugs beforehand.
■ Improving healthcare costs and efficiency. The time and resources that doctors and patients spend finding appropriate medications and doses through “trial and error” is likely to fall as pharmacogenomic tests are developed. —www.Cancer.net
by brant bullard | Jan 25, 2016 | Journal articles
CYP2D6 copy number distribution in the US population
Recently published in Pharmacogenetics and Genomics, the attached article reviews the clinical experience with CYP2D6 mutation rates in a random subset of patients. The reseach points to substantial variation in 2D6 mutations by race. Surprisingly, they found that 20% of African Americans may have aberrant 2D6 activity and as many as 1:300 may be completely missing copies of this gene. 70% of this same group were on a drug metabolized by 2D6.
Pharmacogenetic and Genomics article
This data point underscores the value of pharmacogenetic testing based on personal genetic variation.
For more information on pharmacogenetic testing, contact:
PGx Medical
Individualized Care – Personalized Medicine
info@pgxmed.com
405-509-5112
by brant bullard | Jan 6, 2016 | Metabolic Validation Program
PGx Medical starts the new year with the addition of bipolar and seizure to their medication classes.
Pharamcogenetic Testing:
PGx Medical test results provide clinicians with valuable patient-specific information to make better therapeutic treatment decisions. Medications may be assessed in the following areas of clinical care: hypertension, hyperlipidemia, arrhythmia, anti-coagulation, thrombophilia, depression, psychosis, anxiety, ADHD, pain (including musculoskeletal, arthritis, migraine and neuropathic), bipolar and seizure.
With the PGx Medical Metabolic Validation Program you will receive a customized patient report which includes personalized result interpretations and actionable treatment recommendations.
By adding bipolar and seizure medications, PGx Medical now reports on 19 genes and 16 medication classes to help physicians target treatment and medications to each individual patient’s genetics. This takes away the “trial and error” process by finding a medication that works best for each person. With a simple buccal swab of the cheek, physicians will now know what medications a patient has the ability to metabolize, and which ones they don’t. Guiding them in dosing decisions and helping the patient live a better quality of life.
“We’re excited about 2016 and the enhancements to our program that we will rollout. Adding the two medication classes is just the beginning. Through our local and national partnerships, we have been able to educate and implement our Metabolic Validation Program in hundreds of homes, clinics and pharmacies across the country. We look forward to expanding our work to many more physicians and care providers who desire to increase medical efficiencies, reduce costs, and ultimately give the best care possible to each individual patient,” Clay Bullard, President, PGx Medical.
For more information or to schedule an appointment, contact:
PGx Medical
Individualized Care – Personalized Medicine
405-509-5112
info@pgxmed.com
www.pgxmed.com
by brant bullard | Dec 30, 2015 | Metabolic Validation Program
It is hard to believe that 2015 is coming to a close. From all of us at PGx Medical, we wish you a safe and Happy New Year!
We want to start by saying “thank you” to our partners, clients and employees. We are truly blessed to have such a wonderful team!
In January 2015, we officially settled in our new corporate headquarters in Edmond, OK. This office has given us the space we need to hire more staff to continue our high level of customer service.
Our goal this past year was to educate healthcare proffessionals across the country on the benefits of Metabolic Validation, via pharmacogenetic testing. We started the year by partnering with organizations that play a huge part in quality care for senior communities. These partnerships are vital as we all have the same common goal – to help senior communities provide the best care possible. Through those partnerships, we were able to educate and implement the program in hundreds of homes, clinics and pharmacies across the country. Tailoring treatments uniquely to each individual and guiding healthcare professionals in dosing.
In 2015, I was privileged to speak to many homes, conferences and organizations about our program and how medication management can help reduce falls, unnecessary medications, and help residents have a better quality of life. Below are just a few.
- Touchmark at Coffee Creek
- LeadingAge Oklahoma
- Sterling House in Stillwater
- Virginia Assisted Living Spring Conference
- Oklahoma Residental Assisted Living Association (ORALA)
- Oklahoma Osteopathic Association (OOA)
- Oklahoma Association of Healthcare Providers (OAHCP)
- American Indian Chamber of Commerce (AICCO)
- LeadingAge Missouri Annual Conference
- Oklahoma Foundation of Medical Quality (OFMQ)
- Oklahoma Hospice Association Conference
I also had the privilege to educate Oklahoma State Surveyors on this tool and speak at Provider Training Meetings throughout the year.
Our program was also highlighted in many print publications, as well as radio and tv. Physicians and health providers across the state wrote testimonials and case studies on outcomes based on changes from test results. We are appreciative and humbled by their willingness to share these stories.
Pharmacogenetic testing has received a lot of attention uner the umbrella of Precision Medicine, and we are exited to see that continue.
My team and I look forward to your continued work with our current customer and partners; as well as, expanding our work to many more physicians and care providers who are desiring to increase medical efficiencies, reduce cost, increase better outcomes, and ultimately do the best they can do for each individual patient.
Enjoy the holidays! As always, you can contact us anytime with questions or comments.
PGx Medical
Individualized Care – Personalized Medicine
www.pgxmed.com
405-509-5112
info@pgxmed.com
by brant bullard | Dec 20, 2015 | Journal articles
Personalized medicine is an area of medicine that is only moving in one direction, forward. The more we know the better our care will be.
What works for one person does not always work the same way for someone else. So it should not be a surprise that people and their prescription drug outcomes are not created equal.
In a recent article in prescriptionintelligence.com, they discuss our genes and how they can impact a drug’s effectiveness and its potential side effects. Before DNA testing became widespread in forensics, and crime shows blanketed over primetime broadcast television, distinguishing bloodtypes was the most effective forensic tool. In the mid 20th Century, if a common blood type was found at a crime scene it would be little help to the investigation, but if a rare blood type was discovered the forensic science would be significant. DNA profiling has completely changed every aspect of forensic science. Genetic mapping and pharmacology are having a similarly ascendant moment in medicine. Everyday brings a new discovery and there is plenty of work remaining, but the importance of these advances are indisputable. Genetics will only prove to be more and more important in individual patient care.
Full genetic mapping for every patient is currently impractical and unaffordable. Even if doctors had every patient’s genome mapped, not all information is relevant when considering drug interactions and effectiveness. However there are certain genes and genetic expressions where current science has a depth of knowledge. In these areas, genetics and drugs have fostered gene-specific treatments, and further advancements will only broaden the understanding of genetic differences when prescribing medication. As the science and expense of genomic mapping improves, prescription drug outcomes guided by pharmacogenetics will improve and costs should be lowered across all areas.
Specific genes impact liver function, and different people have different outcomes with medications based on certain genetic predispositions. These variations in genetic expression are called polymorphisms. Many drugs are broken down by the liver and they can be separated into two categories: drugs that enter the body in an active or inactive form.
For drugs that are already in an active form — which means that the drug has immediate effect on the body — enzymes in the liver break the drug down to make it inactive, so the body can then discard it.
Genetic variations within liver metabolism can cause some patients to have decreased metabolism or increased metabolism of the drug, resulting in increased or decreased efficacy, and effecting variation in side effects or interactions with other drugs.
The other category of drugs enter our bodies in an inactive state as a pro-drug, and are activated when they are broken down in the liver. The liver enzymes that break the drug down are critical to making it work. For drugs that are converted into an active [form] in the liver, genetic variations can mean that a person needs to take a different kind of drug entirely.
In this scenario it has been discovered that some drugs are significantly more effective than others in reducing negative outcomes. The way the body absorbs a medication impacts not just the proper dose for optimal care, but the prescribed medication itself. Genetic information can lead to better outcomes and the applications are very real in many areas of pharmacological science.
The public sector is invested in personalized and genomic medicine. President Obama’s 2015 State of the Union Address called for the launch of the Precision Medicine Initiative. Just recently the NIH announced it “has committed up to $72 million in preliminary funding opportunities for the [PMI] in 2016.”
With a public policy backing and a clear economic initiative, personalized medicine will be a major component of future health science. The medical and financial benefits will be hard to predict, but the impact will be enormous. With the rate of scientific discovery and advancement of big-data in every area of healthcare, it is easy to foresee genomic mapping improving the outcomes of medical treatment while reducing the costs once benefits are mainstreamed. The future may already be here, but it is far from being fully explored:
It is easier to imagine a future where one hundred would seem like a small number of drugs with pharmacogenetic labels. Genetic data will soon become ubiquitous in every element of care. New genetic discoveries and market forces will increase efficiency and lower costs, hastening the advent of mainstream precision medicine.
For more information on pharmacogenetic testing, contact:
PGx Medical
Individualized Care – Personalized Medicine
Info@pgxmed.com
405-509-5112
source: prescriptionintelligence.com